CMS Releases Flawed Preliminary CLFS Payment Rates

Sep 25, 2017

On Sept. 22, the Centers for Medicare and Medicaid Services released its preliminary revised Clinical Laboratory Fee Schedule (CLFS) as a result of sec. 216 of the Protecting Access to Medicare Act. These proposed payment rates will impose profound changes in the way Medicare pays for services reimbursed under the CLFS. ASCP is currently in the process of reviewing these payment rates but a preliminary review reveals that these codes do not reflect “true market rates,” as required by Congress.

ASCP is concerned that the Agency’s preliminary payment rates are likely to impose significant economic hardship on many U.S. clinical laboratories and have the potential to restrict access to critical laboratory services for America’s patients—not just Medicare beneficiaries. ASCP believes that much of the negative financial impact is attributable to the CMS’ flawed data collection methodology. Specifically, the Agency refused to include data from hospital laboratories and physician-owned laboratories, which typically receive more robust reimbursement rates than independent laboratories. On several occasions, Congress has attempted to instruct the CMS that data from these laboratories should be included in the CMS’ calculation of new payment rates.

ASCP has repeatedly urged the CMS to reverse its position on the exclusion of payment rate data from hospital and physician-owned laboratories. ASCP will work closely with its pathology and laboratory partners, including the American Clinical Laboratory Association and the College of American Pathologists, to delay the implementation of these new payment rates to allow time for the Agency to develop true market rates as required by law. ASCP will keep its membership informed of developments on the proposed rates and will submit formal comments on the flawed payment rates.